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  • [JAMA Oncol.] Association of Smoking Status With Recurrence, Metastasis, and Mortality Among Patients With Localized Prostate Cancer Undergoing Prostatectomy or Radiotherapy: A Systematic Review and Meta-analysis.

    Medical University of Vienna / Foerster B*

  • 출처
    JAMA Oncol.
  • 등재일
    2018 Jul 1
  • 저널이슈번호
    4(7):953-961. doi: 10.1001/jamaoncol.2018.1071.
  • 내용

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    Abstract
    Importance:
    Studies investigating the association of cigarette smoking with prostate cancer incidence and outcomes have revealed controversial results.

    Objective:
    To systematically review and analyze the association of smoking status with biochemical recurrence, metastasis, and cancer-specific mortality among patients with localized prostate cancer undergoing primary radical prostatectomy or radiotherapy.

    Data Sources:
    A systematic search of original articles published between January 2000 and March 2017 was performed using PubMed, MEDLINE, Embase, and Cochrane Library databases in March 2017.

    Study Selection:
    Observational studies reporting Cox proportional hazards regression or logistic regression analyses were independently screened.

    Data Extraction and Synthesis:
    This systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane Handbook for Systematic Reviews of Interventions. Available multivariable hazard ratios (HRs) and corresponding 95% CIs were included in quantitative analysis. A risk-of-bias assessment was completed for nonrandomized studies.

    Main Outcomes and Measures:
    Prespecified outcomes of interest were biochemical recurrence, metastasis, and cancer-specific mortality.

    Results:
    A total of 5157 reports were identified, of which 16 articles were selected for qualitative analysis and 11 articles were selected for quantitative analysis. All included studies were observational and nonrandomized and comprised a total of 22 549 patients. Overall, 4202 patients (18.6%) were current smokers. The overall median follow-up was 72 months. Current smokers had a statistically significantly higher risk of biochemical recurrence (HR, 1.40; 95% CI, 1.18-1.66; P < .001 [10 studies]), as did former smokers (HR, 1.19; 95% CI, 1.09-1.30; P < .001 [7 studies]). Current smokers were also at a higher risk of metastasis (HR, 2.51; 95% CI, 1.80-3.51; P < .001 [3 studies]) and cancer-specific mortality (HR, 1.89; 95% CI, 1.37-2.60; P < .001 [5 studies]), whereas former smokers were not (metastasis: HR, 1.61; 95% CI, 0.65-3.97; P = .31 [2 studies]; cancer-specific mortality: HR, 1.05; 95% CI, 0.81-1.37; P = .70 [4 studies]).

    Conclusions and Relevance:
    Current smokers at the time of primary curative treatment for localized prostate cancer are at higher risk of experiencing biochemical recurrence, metastasis, and cancer-specific mortality.

     


    Author information

    Foerster B1,2, Pozo C1,3, Abufaraj M1,4, Mari A1, Kimura S1,5, D'Andrea D1, John H2, Shariat SF1,6,7,8.
    1
    Department of Urology, Medical University of Vienna, Vienna, Austria.
    2
    Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland.
    3
    Department of Urology, Hospital Universitario Fundación Alcorcón, Madrid, Spain.
    4
    Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan.
    5
    Department of Urology, Jikei University School of Medicine, Tokyo, Japan.
    6
    Department of Urology, Weill Cornell Medical College, New York, New York.
    7
    Department of Urology, University of Texas Southwestern Medical Center, Dallas.
    8
    Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.

  • 편집위원

    Prostate cancer 예후와 smoking의 연관성에 대해서 아직 확정적인 근거가 없는 시점에서 본 체계적 고찰 및 메타분석은 임상진료시 prostate cancer 환자들에게 금연의 중요성을 강조하는 근거수준이 높은 연구결과이다.

    2018-08-24 15:58:05

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